What is the recommended treatment for herpangina?

Treatment of Herpangina

Herpangina treatment is primarily symptomatic and supportive, focusing on pain relief, adequate hydration, and appropriate nutrition, with consideration of topical oral sprays and antiviral medications in selected cases. 1

Understanding Herpangina

Herpangina is a common childhood infectious disease caused by enteroviruses, primarily Coxsackievirus-A serotypes, Enterovirus-A, and Echovirus. It typically presents with characteristic vesicular or ulcerative lesions on the posterior pharynx and soft palate, accompanied by fever and sore throat.

Treatment Algorithm

First-Line Management: Symptomatic Relief

1. Pain Management

   • Oral analgesics:
     • Ibuprofen or acetaminophen for pain relief 2
     • Dosing based on patient age and weight
   • Topical pain relief:
     • Benzydamine spray (0.255 mg/dose, 6 doses 3 times daily) 3
     • Alternative: mixture of Maalox and diphenhydramine or viscous lidocaine 2

2. Hydration

   • Encourage adequate fluid intake
   • Consider IV fluids if oral intake is severely compromised due to pain 2
   • Cold beverages may provide additional comfort

3. Nutrition

   • Soft, non-acidic foods
   • Avoid salty, spicy, and irritating foods 3
   • Cold foods may be better tolerated

Adjunctive Therapies

1. Topical Treatments

   • Oral sprays with local anesthetic properties
   • White soft paraffin ointment applied to lips every 2 hours to prevent cracking 2

2. Antiviral Considerations

   • Inosine pranobex (50 mg/kg/day divided into 4 doses) may be considered in selected cases 3
   • Note: While used in some clinical cases, strong evidence for antiviral efficacy in herpangina is limited

Special Populations

1. Immunocompromised Patients

   • More aggressive symptom management
   • Consider early antiviral therapy
   • Closer monitoring for complications 2

2. Severe Cases

   • If unable to maintain hydration: hospitalization for IV fluids
   • For severe pain: more aggressive pain management protocol

Duration and Follow-up

• The typical course of herpangina lasts 4-6 days with good prognosis 1
• Follow-up is recommended if:
  • Symptoms worsen
  • No improvement after 72 hours
  • New symptoms develop
  • Patient is immunocompromised 2

Prevention Measures

• Hand washing is crucial - shown to have significant protective effect against herpangina 4
• Avoid close contact with infected individuals
• Avoid crowded places during outbreaks 4
• Proper disinfection of contaminated surfaces and items

Common Pitfalls to Avoid

1. Overuse of antibiotics - Herpangina is viral in etiology, antibiotics are ineffective unless secondary bacterial infection is present
2. Inadequate pain management - Underestimating pain can lead to poor oral intake and dehydration
3. Neglecting oral hygiene - Maintaining oral hygiene helps prevent secondary infections
4. Delayed treatment of dehydration - Early intervention for hydration issues is essential

The management approach should focus on symptom relief while the infection runs its self-limited course, with special attention to maintaining adequate hydration and nutrition during the acute phase of illness.